MEDICARE: JOEL F BOOKOUT D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS00004397	TN

General Provider Information

NPI Number	:	1235138884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL F BOOKOUT D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 9373
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37412-0373
Country	:	US
Telephone Number	:	423-698-3607
Fax Number	:

Provider Business Practice Location Address
First Line	:	4141 RINGGOLD RD
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37412-2465
Country	:	US
Telephone Number	:	423-698-3607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2005
Last Update Date	:	07/08/2007

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